Dysautonomia: When Your Body's "Autopilot" Malfunctions — The 32 Symptoms, Primary vs Secondary Causes, Diagnosis, Treatment and Outlook — What You Need to Know

Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026

Emergency: Call 911 or your local emergency number for chest pain, trouble breathing, or a heartbeat that is unusually slow, racing or pounding. Some dysautonomia symptoms are hard to tell apart from a medical emergency, so when in doubt, call. [1]

Quick Answer

Dysautonomia is a term for conditions that disrupt the autonomic nervous system, the network that manages processes you don't consciously control, such as blood pressure, heart rate, breathing and digestion. [1] It can cause mild to severe symptoms. [1] It affects more than 70 million people worldwide. [1] There is no cure, but many symptoms are manageable with lifestyle changes and medications. [1]

What the research says

• POTS is more likely after SARS-CoV-2 infection than after vaccination. Pooling 5 studies of infected people and 2 of vaccinated people, the POTS rate was about 107.75 per 10,000 (1.08%) after infection versus 3.94 per 10,000 (0.039%) after vaccination, and POTS was 2.12 times more likely in infected than uninfected people (RR 2.12, 95% CI 1.71–2.62). (Yong et al., Auton Neurosci, 2023) [2]

• Autonomic nerve damage to the heart is common in diabetes. Across 21 studies, the pooled prevalence of cardiovascular autonomic neuropathy in people with type 1 diabetes was 25.8% (95% CI 20.8–30.7%). (Huang et al., Rev Cardiovasc Med, 2024) [3]

• Orthostatic hypotension affects about 1 in 4 people with heart failure. In 9 studies (10 cohorts) with 2,036 patients, the pooled prevalence was 26.7% (95% CI 20.4–34.2%), though results varied widely between studies. (Coscetta et al., Eur J Intern Med, 2026) [4]

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Dysautonomia is not a single disease. It is an umbrella term for many conditions in which the autonomic nervous system, your body's "autopilot," malfunctions. It can affect nearly every automatic process in the body, from heart rate and blood pressure to digestion, sweating and bladder control, which is why symptoms can feel unrelated and diagnosis is often delayed.

At a glance	What you need to know
What it is	Disruption of the autonomic nervous system, which runs processes you don't consciously control.
Also called	Autonomic dysfunction or autonomic neuropathy.
How common	More than 70 million people worldwide have some form.
Average onset	Symptoms commonly begin between ages 50 and 60.
Can it be prevented?	No. It happens unpredictably, for reasons experts don't yet fully understand.
Is it curable?	No cure exists, but many symptoms are manageable.
How long does it last?	Some forms are temporary, but it is usually lifelong.
Can it be serious?	Yes. Severe forms may affect work and daily activities, and may cause deadly complications.

What Exactly Is the Autonomic Nervous System?

The autonomic nervous system (ANS) is a subdivision of your overall nervous system. The word "autonomic" literally means "self-governing." [1] This is the part of your body that manages processes you do not have to think about: blood pressure, body temperature, breathing, digestion, heart rate and sweating. [1]

Think of it as your body's autopilot. You do not consciously tell your heart to beat or your digestive tract to move food along; the ANS handles it continuously in the background. If you have dysautonomia, one or more of these automatic processes is not working as it should. The result can be symptoms in nearly any part of the body, which is why the condition can be confusing for both patients and providers.

What Are the Signs and Symptoms of Dysautonomia?

Symptoms can appear in nearly every body system, because the ANS touches nearly every body system. The list below is not exhaustive.

Cardiovascular symptoms

Heart and blood pressure symptoms are among the most recognizable. They include chest pain or discomfort, a fast heart rate (tachycardia), a slow heart rate (bradycardia), an irregular heart rhythm (arrhythmia), heart palpitations, dizziness or lightheadedness (especially when standing up), and fainting or passing out, particularly upon standing. [1]

Brain and mental symptoms

Cognitive and emotional symptoms include "brain fog," forgetfulness, trouble focusing, fatigue or ongoing tiredness, mood swings, anxiety, sleeping problems, and sensitivity to sound or light. [1]

Digestion and bladder symptoms

Digestive symptoms include nausea and vomiting, changes in bowel movements (constipation or diarrhea), and trouble swallowing (dysphagia). Low blood sugar (hypoglycemia) can also occur. [1] Bladder and kidney-related symptoms include a frequent urge to urinate and urinary incontinence. [1]

Eye, breathing, skin and other symptoms

Eye symptoms include pupils that are pinpoint or unusually wide, unusually dry or watery eyes, blurred vision, and trouble with the eyes adjusting to light changes. Breathing symptoms include shortness of breath (dyspnea) and a runny nose. Skin and temperature symptoms include clammy or pale skin, sweating more or less than usual or in certain body parts, swings in body or skin temperature, and excessive drooling. Other symptoms include sexual dysfunction, balance problems, vertigo, migraines or frequent headaches, and exercise intolerance, in which your heart rate does not change as it should with physical activity. [1]

Body system	Possible symptoms
Heart and circulation	Chest pain or discomfort; fast or slow heart rate; irregular rhythm; palpitations; dizziness or lightheadedness when standing; fainting when standing.
Brain, mood, cognition	"Brain fog," forgetfulness, trouble focusing; fatigue; mood swings or anxiety; sleeping problems; sound or light sensitivity; migraines or frequent headaches.
Digestion	Nausea and vomiting; constipation or diarrhea; trouble swallowing; excessive drooling; low blood sugar.
Bladder and kidneys	Frequent urge to urinate; urinary incontinence.
Eyes	Pinpoint or unusually wide pupils; unusually dry or watery eyes; blurred vision; trouble adjusting to light changes.
Breathing	Shortness of breath; runny nose.
Skin and temperature	Clammy or pale skin; sweating more or less than usual, or in certain body parts; swings in body or skin temperature.
Other	Sexual dysfunction; balance problems; vertigo; exercise intolerance.

What Causes Dysautonomia: Primary vs Secondary?

There are two main types. Primary dysautonomia happens on its own without another underlying cause and is less common. [1] Secondary dysautonomia happens because of another condition. [1]

What is primary dysautonomia, and who is at higher risk?

Primary dysautonomias happen on their own, without a specific cause. A specific example is familial dysautonomia, an inherited form. Your odds of having it increase if you are of Jewish (especially Ashkenazi Jewish) heritage, of Eastern European heritage, or have a family member with dysautonomia, especially a first-degree relative such as a parent or sibling. [1] Another primary form is called "idiopathic" dysautonomia, which means it happens for a reason that healthcare providers cannot explain or detect. [1]

What conditions cause secondary dysautonomia?

Many conditions can cause or contribute to dysautonomia, including the following.

Category	Conditions and causes
Neurological conditions	ALS ("Lou Gehrig's disease"), Lewy body dementia, multiple sclerosis and neuromyelitis optica, multiple system atrophy (MSA), Parkinson's disease, spinal cord injury, traumatic brain injury, stiff person syndrome, Chiari malformation, brain tumors.
Immune and autoimmune	Autoimmune autonomic ganglionopathy (AAG), lupus, rheumatoid arthritis, Sjögren's syndrome, sarcoidosis, Ehlers-Danlos syndrome and other connective tissue disorders.
Infections and toxins	Lyme disease, COVID-19 (especially long COVID), botulism, tetanus, toxins, poisons or heavy metals (mercury, arsenic, organophosphates found in pesticides).
Metabolic and nutritional	Type 2 diabetes, porphyria (especially acute intermittent), vitamin B12 deficiency, Wernicke-Korsakoff syndrome (vitamin B1 deficiency).
Other autonomic disorders	Orthostatic hypotension, postural orthostatic tachycardia syndrome (POTS), vasovagal syncope, autonomic dysreflexia, pure autonomic failure, primary focal hyperhidrosis.
Other causes	Amyloidosis, complex regional pain syndrome (CRPS), Guillain-Barré syndrome, neuroleptic malignant syndrome, serotonin syndrome, medications or medical procedures.

Can dysautonomia be prevented?

No. Dysautonomia happens unpredictably and for reasons experts do not yet understand. It is not possible to prevent it or to lower your risk of having it. [1]

What Are the Complications of Dysautonomia?

Because dysautonomia affects vital body processes, there are many possible complications. Most of them revolve around the symptoms themselves, especially when symptoms are severe or disrupt your usual routine and activities.

Complication	Why it happens
Heart rate problems	Heart rate that is too fast, too slow, or irregular.
Fainting	Fainting episodes, which can lead to injuries from falls.
Breathing problems	Trouble breathing.
Digestive disruption	Disrupted digestion, which may lead to constipation, diarrhea or other problems.
Kidney disruption	Disrupted kidney function, leading to urinary tract infections or incontinence.

Important: In severe cases, dysautonomia may cause deadly complications. [1] Depending on the cause, it may be a minor concern, but chronic or incurable underlying causes can have much larger impacts on daily life and the ability to work or take part in activities.

How Is Dysautonomia Diagnosed?

Diagnosis is often partly a process of elimination. [1] Providers work to determine how and when symptoms happen and to find the pattern that links them. Even experienced providers may find dysautonomia challenging to diagnose, because it can cause symptoms throughout the body that may not seem connected. Providers may also link symptoms to whatever condition is causing the dysautonomia without realizing dysautonomia is happening as well. [1]

Test	What it looks at
Physical and neurological exam	Baseline assessment of nerves, reflexes and overall health.
Tilt table test	How blood pressure and heart rate respond to position changes.
Heart tests (especially EKG)	Heart rhythm and electrical activity.
Sweat tests (e.g., QSART)	Sweating nerve function, using the quantitative sudomotor axon reflex test.
Pupillometry	Pupil measurement to assess eye-related autonomic function.
Ultrasound and related tests	Symptoms related to urinary incontinence.
Blood tests	Antibodies that indicate an autoimmune disorder; levels of neurotransmitters such as catecholamines.

Many other tests are possible depending on your symptoms; your provider can advise which may help.

How Is Dysautonomia Treated, and Is There a Cure?

There is no cure for dysautonomia, but many symptoms are manageable. [1] The treatment approach depends strongly on several factors, especially what is causing it. [1]

Treatment approach	How it helps
Diet changes	Increasing salt intake can raise blood pressure, keeping it from plunging as much when you stand.
Hydration	Keeping hydrated helps maintain blood pressure.
Blood pressure medications	Helpful when you have orthostatic hypotension and its related effects.
Immune-suppressing or other immune-system treatments	Can treat dysautonomia driven by autoimmune conditions.
Stopping the offending cause	When dysautonomia is caused by a medication or medical treatment, stopping that medication or reversing that treatment is usually a priority.

Because there are so many possible treatments, your provider is the best source of information about options, side effects and complications specific to your situation.

What Should I Do When Symptoms Strike?

Lightheadedness and dizziness often reverse themselves if you sit or lie down, because this makes it easier for blood flow to reach your brain. [1] Most people also regain consciousness after fainting for the same reason. But some symptoms are difficult to tell apart from a medical emergency.

Call 911 or your local emergency number when in doubt. Emergency symptoms include chest pain, trouble breathing, and a heartbeat that is unusually slow, racing, pounding, or that you are unpleasantly aware of without trying to feel it (heart palpitations). [1] Other symptoms may also need emergency attention, and your provider can advise which to watch for.

Emergency symptom	Action
Chest pain (see also heart attack symptoms)	Call 911 or your local emergency number.
Trouble breathing	Call 911 or your local emergency number.
Abnormal heartbeat (slow, racing, pounding, or palpitations)	Call 911 or your local emergency number.
Any symptom that feels like an emergency	When in doubt, call 911 or your local emergency number.

When should I see my provider?

Your provider will likely recommend a regular schedule of follow-up visits, which remain important even if nothing seems to have changed. They track your symptoms and check vital signs you cannot feel, such as blood pressure. [1] Contact your provider if you notice a change (positive or negative) in your symptoms, a change in how well your medications work, or if something in your life changes in a way that influences your symptoms or how you manage them. [1]

How Can I Live Well With Dysautonomia?

Many people with dysautonomia struggle to find a provider who can diagnose and treat it, and frustration or anxiety about medical care is common. [1] You can take proactive steps.

Self-care step	Why it helps
Find a provider you feel comfortable with	Your relationship with your provider is crucial; seek a second opinion if you are not listened to or they lack the necessary experience.
Keep a daily symptom journal	Detailed records of symptoms, activities and feelings help your provider see the bigger picture and adjust treatment.
Stay organized	A system for tracking symptoms, condition and treatment reduces anxiety and communicates more to providers.
Be prepared for appointments	Keep printed research articles handy, and take water, a snack and needed medications to visits to avoid or limit symptoms at inconvenient times.
Advocate for yourself	Ask a trusted loved one to come with you to events and appointments, briefed on your concerns and how to help.

What can and can't I eat or drink?

Your provider will likely recommend changes to what you eat and drink, which often include, but are not limited to: avoiding alcohol, staying hydrated, adding salt as recommended, making sleep and rest a priority, managing stress, reaching and maintaining a healthy weight, taking breaks as necessary, avoiding heat (use warm water instead of hot for bathing), moving around to avoid sitting or standing too long, monitoring caffeine intake as your provider recommends, taking medications as prescribed, and talking to your provider before adding any new over-the-counter supplements. [1]

What are common triggers I should avoid?

Dysautonomia can have triggers that make symptoms happen suddenly or worsen. Knowing and tracking your triggers, especially with a journal, can help you avoid them. [1] Tell your provider if you suspect a trigger not listed here.

Common trigger	Example
Alcohol	Drinking alcohol can trigger or worsen symptoms.
Dehydration	Inadequate fluid intake.
Stress	Emotional or physical stress.
Tight clothing	Restrictive garments.
Hot environments	Heat exposure.
Certain drugs	Nonmedical drug use, especially drugs that slow nervous system activity, such as benzodiazepines or opioids.

What Is the Outlook (Prognosis) for Dysautonomia?

Dysautonomia looks very different from person to person, even among family members. [1] Your symptoms may be totally different from someone else's, and the impact on your life can vary widely. The condition is unpredictable: some people experience frequent symptoms, while others go months or even years without any. [1] Depending on the cause, dysautonomia may be a minor concern, but chronic or incurable underlying causes may have larger impacts. In severe cases, symptoms may affect your ability to work or take part in activities you enjoy, and the condition may also cause deadly complications.

Many people with dysautonomia have difficulty getting a diagnosis, and frustration, anxiety or other difficult emotions around symptoms are common. Some forms may be temporary, but it is usually a lifelong condition. [1]

Conclusion: You Are Not Alone, and Help Exists

Dysautonomia is a broad, sometimes bewildering category of conditions in which the body's automatic control systems misbehave. Because its symptoms can touch nearly every organ system, getting a clear diagnosis often takes time, and living with it can feel isolating. But the picture is not hopeless: more than 70 million people worldwide share some form of this condition, and many symptoms are manageable through salt, hydration, blood pressure medications, immune therapies and careful management of underlying causes. [1]

Next Steps for Health

If you recognize several of these symptoms in yourself, especially dizziness when standing, fainting, unusual heart rhythms or unexplained digestive and sweating changes, do not try to manage them alone. Talk to a healthcare provider, keep a detailed daily journal of what you experience, and ask for a referral to a provider with experience in autonomic disorders. If you have chest pain, trouble breathing or an abnormal heartbeat, call 911 or your local emergency number right away.

Questions to ask your provider

• How serious is the type of dysautonomia I have?

• What symptoms mean I need to call your office or seek medical care?

• What signs of complications should I look out for?

• Which autonomic processes does my dysautonomia affect?

• What type of treatment and lifestyle adjustments are best for me?

• What might I expect to happen to my health in the future?

• What kinds of support groups are available?

• Are there specialists for diet, mental health and stress support?

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Frequently Asked Questions

1. What is dysautonomia in simple terms?

Dysautonomia is the general term for conditions that disrupt the autonomic nervous system, the network that automatically manages blood pressure, body temperature, breathing, digestion, heart rate and sweating.

2. What does "autonomic" mean in dysautonomia?

"Autonomic" means "self-governing." The autonomic nervous system runs the processes you do not consciously control.

3. What body systems does dysautonomia affect?

Dysautonomia can cause symptoms involving the heart and blood pressure, digestion, bladder and kidneys, eyes, breathing, skin and temperature regulation, sweating, balance, mood, sleep and thinking.

4. What is another name for dysautonomia?

Dysautonomia is also known as autonomic dysfunction or autonomic neuropathy.

5. How common is dysautonomia?

More than 70 million people worldwide have some form of dysautonomia.

6. At what age does dysautonomia usually start?

The average time of onset is between ages 50 and 60, although it can be present at birth or develop at any point in life.

7. Is dysautonomia the same as POTS?

No. POTS (postural orthostatic tachycardia syndrome) is one of many conditions listed as a form or cause of dysautonomia, alongside orthostatic hypotension, vasovagal syncope and pure autonomic failure.

8. What is the difference between primary and secondary dysautonomia?

Primary dysautonomia happens on its own without another cause. Secondary dysautonomia happens because of another condition, such as diabetes, Parkinson's disease or an autoimmune disorder.

9. Is familial dysautonomia inherited?

Yes. It is an inherited primary form. Risk increases with Ashkenazi Jewish or Eastern European heritage, or a first-degree relative with the condition.

10. What is idiopathic dysautonomia?

Idiopathic dysautonomia is a primary form that happens for a reason healthcare providers cannot explain or detect.

11. Can type 2 diabetes cause dysautonomia?

Yes. Type 2 diabetes is listed among the conditions that can cause or contribute to secondary dysautonomia.

12. Can COVID-19 cause dysautonomia?

Yes. COVID-19 infection, especially long COVID, is listed as a possible cause.

13. What conditions can cause secondary dysautonomia?

More than 30 are listed, including ALS, multiple sclerosis, Parkinson's disease, Lewy body dementia, lupus, rheumatoid arthritis, Sjögren's syndrome, Lyme disease, Guillain-Barré syndrome, spinal cord injury, amyloidosis, vitamin B12 deficiency and heavy metal poisoning.

14. What are the most common symptoms of dysautonomia?

Common symptoms include dizziness when standing, fainting, fast or slow heart rate, palpitations, chest discomfort, brain fog, fatigue, nausea, sweating changes, clammy or pale skin, dry or watery eyes and bowel changes.

15. Why does dysautonomia cause dizziness when standing?

Dysautonomia disrupts the automatic control of blood pressure, so pressure can drop when you stand. Sitting or lying down often relieves it because blood flow reaches the brain more easily.

16. Can dysautonomia cause fainting?

Yes. Fainting, especially when standing up, is a recognized symptom and can lead to injuries from falls.

17. Can dysautonomia affect digestion?

Yes. It can disrupt digestion, causing constipation, diarrhea, nausea, vomiting and trouble swallowing.

18. Can dysautonomia affect the bladder and kidneys?

Yes. It can disrupt kidney function, leading to urinary tract infections or incontinence, and cause a frequent urge to urinate.

19. How is dysautonomia diagnosed?

Diagnosis combines methods and tests and is often partly a process of elimination. Providers look at how and when symptoms happen and the pattern linking them.

20. What is a tilt table test?

A tilt table test is one of the tests that may help diagnose dysautonomia by showing how blood pressure and heart rate respond to changes in body position.

21. What is a sweat test (QSART)?

The quantitative sudomotor axon reflex test assesses the nerves that control sweating, which are part of the autonomic nervous system.

22. Why is dysautonomia hard to diagnose?

Dysautonomia can cause symptoms throughout the body that may not seem connected, and providers may link symptoms to an underlying condition without realizing dysautonomia is also happening.

23. Is there a cure for dysautonomia?

No. There is no cure, but many symptoms are manageable.

24. How is dysautonomia treated?

Treatment depends strongly on the cause and may include more salt, hydration, blood pressure medications, immune-system treatments and stopping a medication or treatment that is the cause.

25. Why does increasing salt help with dysautonomia?

More salt can raise blood pressure, keeping it from dropping as much when you stand.

26. Can dysautonomia be prevented?

No. It happens unpredictably and for reasons experts do not yet understand, so it cannot be prevented.

27. Is dysautonomia lifelong?

Some forms may be temporary, but it is usually a lifelong condition.

28. Can dysautonomia be deadly?

In severe cases, yes. Depending on the cause it may be a minor concern, but severe forms can affect work and daily activities and may cause deadly complications.

29. What are the emergency symptoms of dysautonomia?

Call 911 or your local emergency number for chest pain, trouble breathing, or a heartbeat that is unusually slow, racing or pounding. When in doubt, call.

30. What lifestyle changes help with dysautonomia?

Providers often recommend avoiding alcohol, staying hydrated, adding salt as advised, prioritizing sleep, managing stress, keeping a healthy weight, avoiding heat and moving around rather than sitting or standing too long.

31. What triggers make dysautonomia symptoms worse?

Common triggers include alcohol, dehydration, stress, tight clothing, hot environments and nonmedical drug use, especially benzodiazepines or opioids.

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References

1. Cleveland Clinic. Dysautonomia. Cleveland Clinic. Last updated September 11, 2023. https://my.clevelandclinic.org/health/diseases/6004-dysautonomia

2. Yong SJ, et al. Pooled rates and demographics of POTS following SARS-CoV-2 infection versus COVID-19 vaccination: Systematic review and meta-analysis. Autonomic Neuroscience. 2023;250:103132. PMID 38000119. https://doi.org/10.1016/j.autneu.2023.103132

3. Huang X, et al. Prevalence and Risk Factors of Cardiovascular Autonomic Neuropathy in Individuals with Type 1 Diabetes Mellitus: A Systematic Review and Meta-Analysis. Reviews in Cardiovascular Medicine. 2024;25(7):244. PMID 39139439. https://doi.org/10.31083/j.rcm2507244

4. Coscetta F, et al. Prevalence of orthostatic hypotension in heart failure: a systematic review and meta-analysis. European Journal of Internal Medicine. 2026:107116. PMID 42552200. https://doi.org/10.1016/j.ejim.2026.107116

Medical disclaimer

This article is for informational purposes only and does not constitute medical advice. Consult a healthcare professional for diagnosis and treatment. If you think you may have a medical emergency, call 911 or your local emergency number immediately.